National Institutes Health Stroke Score

Modified National Institute of Health Stroke Score of >20 (not an absolute contraindication)... 

Emax Functions Another familiar asymptotic function is the max function, which has a natural limit S , . The E ax model for disease progression has been used to describe the progression of several different disease scores that have a natural hmit associated with the score. Anderson et al. (23) used the E ax model to describe pain resolution in pediatric patients and Taylor et al. (24) used this model to describe recovery from ischemic stroke using the National Institutes of Health Stroke Score. This model adequately described the trajectory of both markers of disease progression and was able to describe wide interpatient variability in disease progression and response. 

Functional recovery following stroke depends on stroke location, stroke size and the severity of resulting neurological deficits. Patients with severe neurological deficits, reflected in higher National Institutes of Health Stroke Score (NIHSS)... 

A recent study compared 144 patients treated within 6 hours of symptom onset with I AT using urokinase versus 147 patients treated with aspirin who were matched for age and stroke severity according to National Institutes of Health Stroke Scale (NIHSS) (median 14). The study demonstrated superiority of LAT to aspirin in patients achieving an mRS score of 0-2 (56% vs. 42%, p = 0.037) and in patients achieving an mRS score of 0-1 at 2 years (40% vs. 24%, p = 0.008) with no difference in mortality (23% vs. 24%). °... 

The abciximab in Acute Ischemic Stroke trial was a randomized, placebo-controlled dose-escalation study to examine the safety of abciximab in acute stroke. It randomized 74 patients within 24 hours of stroke onset to receive one of four doses of abciximab (by bolus with or without additional infusion, 54 patients) or placebo (20 patients). The median baseline National Institute of Health Stroke Scale (NIHSS) score was 15. The rates of asymptomatic ICH were 19% in the intervention group compared to 5% in the placebo group p = 0.07). Most (9 of 11) of the asymptomatic ICH patients had more severe stroke (NIHSS >14). No cases of symptomatic ICH or major systemic bleeding occurred. There was a trend toward a lower rate of stroke recurrence (2% vs. 5%) and a higher rate of functional recovery at 3 months in the group treated with abciximab than with placebo. 

The severity of the neurological deficit at the time of stroke onset is a major predictor of stroke outcome. In an analysis of the placebo-treated patients in the National Institute of Neurological Disorders and Stroke (NINDS) recombinant tissue-plasminogen activator (rt-PA) study, the best acute predictor of a poor outcome at 1 year was an National Institute of Health Stroke Scale (NIHSS) score >17 for patients over 70 years. These criteria had a high specificity (98%), but sensitivity was only 31%. The low sensitivity of the acute NIHSS score alone in predicting... 

Shafqat et al. ° previously validated the National Institutes of Health Stroke Scale (NIHSS) assessment as a reliable method of evaluating patients with stroke symptoms at a bandwidth of 384 kbit/s comparing a bedside neurologist to a telemedicine-enabled neurologist teamed with a bedside nurse in patients with ischemic stroke and NIHSS scores ranging from 1 to 24. There was an excellent correlation between bedside and remote scores (inter-rater correlation coefficient... 

Over a five year period, 1438 patients were referred either to the hospital or to the study cUnic with a suspected TIA or minor stroke (defined on assessment as a score of < 3 on the National Institutes of Health Stroke Scale [NIHSS]) (Wityk et at 1994) (Fig. 10.1). Of these, a pre-scan diagnosis of definite or possible TIA was made in 405 patients (46% male, mean age 74 years), and definite or possible minor stroke in 414 patients (54% male, mean age 76 years). Overall, 97% underwent brain imaging for definite or possible events (699 CT, 93 MRI). 

The risk of stroke following minor stroke has not been studied in such depth. However, in a provisional report from the first year of OXVASC, the risk of stroke among 87 patients with minor stroke (defined as a score of < 3 on the National Institutes of Health Stroke Scale (NIHSS)) was 11.5% (95% Cl, 4.8-11.2) at seven days and 18.5% (95% Cl, 10.3-26.7) at 90 days (Coull et al. 2004). Among patients with minor stroke who were referred to the dedicated neurovascular clinic in the EXPRESS study and did not need immediate admission to hospital, the rates of recurrent stroke at 90 days were 10-8% (17/158) in phase 1, without urgent intervention, and 4.0% (5/125) in phase 2, with urgent intervention (Rothwell et al. 2007) (Ch. 20). 

The FASTER randomized controlled pilot trial studied the benefit of clopidogrel versus placebo and simvastatin versus placebo initiated within 24-hours of symptom onset in patients with TIA or minor stroke, all of whom were treated with aspirin (Kennedy et al. 2007). The primary outcome was any stroke (ischemic and hemorrhagic) within 90 days. Minor stroke was defined as a score < 3 on the National Institutes of Health Stroke Scale (NIHSS) at the time of randomization and TIA was defined in the usual way. In addition, patients were excluded if they did not have weakness or speech disturbance or if symptom duration was less than five minutes. 

The early CT findings listed above not only facilitate stroke detection, but can also help to predict prognosis and the response to thrombolytic therapy [10,13,34-38]. For example, in a stndy that revealed HMCAS in 18 of 55 (33%) patients presenting within 90 min of stroke onset, HMCAS was predictive of poor ontcome after IV thrombolysis, althongh a National Institutes of Health Stroke Scale (NIHSS) score of greater than 10... 

Maas MB, Furie KL, Lev MH et al (2009) National Institutes of Health Stroke Scale score is poorly predictive of proximal occlusion in acute cerebral ischemia. Stroke 40 2988-2993... 

---